Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis

Zhang, Kevin; Rashid-Kolvear, Matin; Waseem, Rida; Englesakis, Marina; Chung, Frances

doi:10.1016/j.jclinane.2021.110540

Cited by 25 publications

(22 citation statements)

References 47 publications

(230 reference statements)

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“…[21][22][23] Previous studies have investigated the efficacy of telemedicine versus in-person preoperative visits regarding cancellation rates. [24][25][26] Our study suggests that preop-erative telemedicine visits may not be associated with greater risk of surgical cancellations for all patients, but they are specifically associated with increased cancellations among those with known cardiac history. It should be noted that the literature is not uniform regarding this finding.…”

Section: Discussionmentioning

confidence: 99%

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments

Siegel

Lambrechts

Issa

et al. 2022

J Am Acad Orthop Surg

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Purpose:The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery.Methods:A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05.Results:A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036).Discussion:Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.

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Section: Discussionmentioning

confidence: 99%

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments

Siegel

Lambrechts

Issa

et al. 2022

J Am Acad Orthop Surg

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“…[2][3][4] Although guidelines have suggested medical encounters most suited for virtual care are those that do not require a physical exam, 5 a recent systematic review reported that virtual preanesthetic assessments had high patient satisfaction, similar surgical cancelation rates, and lower costs compared with in-person assessments. 6 The COVID-19 pandemic prompted a dramatic increase in virtual care. 7 An airway evaluation is traditionally performed in-person but does not require special equipment; therefore, conducting an airway evaluation remotely using virtual videoconferencing technologies is plausible.…”

Section: Abstract Airway Evaluationmentioning

confidence: 99%

Évaluation de la fiabilité de l’évaluation préanesthésique virtuelle des voies aériennes en comparaison à l’évaluation traditionnelle en personne : une étude observationnelle prospective

Zhao

McKay

Hedlin

et al. 2022

Can J Anesth/J Can Anesth

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Purpose Airway evaluation is a fundamental component of the preanesthetic examination. Virtual care has increased during the COVID-19 pandemic. We aimed to assess the reliability of a virtual preanesthetic airway evaluation compared with a traditional in-person airway evaluation. Methods This prospective observational study compared the inter-rater agreement of an in-person airway evaluation performed by a consultant anesthesiologist with a virtual airway evaluation (VAE) performed by consultant anesthesiologists and medical students. The airway evaluation was completed using a comprehensive airway evaluation and scoring tool. The primary outcome was the inter-rater agreement of total scores between inperson anesthesiologist airway evaluations and the VAEs of both the anesthesiologists and medical students, assessed using Cohen's Kappa (CK). Secondary outcomes included the inter-rater agreement for each airway evaluation component between the in-person anesthesiologists and both the anesthesiologist and medical student VAEs, assessed using prevalenceadjusted and bias-adjusted Kappa. Results One hundred out of 111 participants completed all three evaluations. The in-person anesthesiologist airway evaluations had fair and good levels of agreement of total scores with the VAEs of the anesthesiologists (CK, 0.21; 97.5% confidence interval [CI], 0.07 to 0.34) and the medical students (CK, 0.74; 97.5% CI, 0.62 to 0.86), respectively. One participant was reported to have a difficult intubation. Conclusion Virtual airway evaluations performed by anesthesiologists and medical students had fair and good inter-rater agreement, respectively, with in-person anesthesiologist airway evaluations. Further study with a focus on patients with difficult airways is required to define the predictive value of VAEs regarding difficult intubations. Re ´sumeÓbjectif L'e´valuation des voies ae´riennes constitue un e´le´ment fondamental de l'examen pre´anesthe´sique. Les soins prodigue´s virtuellement ont augmente´pendant la pande´mie de COVID-19. Nous avons tente´d'e´valuer la fiabilite´d'une e´valuation pre´anesthe´sique virtuelle des voies ae´riennes par rapport a`une e´valuation traditionnelle en personne.Me ´thode Cette e´tude observationnelle prospective a compare´la concordance inter-observateurs d'une e´valuation des voies ae´riennes en personne effectue´e par un anesthe´siologiste avec une e´valuation virtuelle des voies

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“…Additionally, anesthesiologists increasingly utilized telemedicine for pain management in both rural and urban healthcare settings [9]. The in-person preoperative anesthesia consultation serves multiple purposes including patient education, optimization of comorbid conditions, and perioperative risk reduction [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis

Le,

Burton,

Tejeda

et al. 2024

Cureus

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Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, the sudden demand for virtual medical visits drove the expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge of the impact of telehealth on appointment adherence, particularly in preoperative anesthesia evaluations. This study aims to describe the impact of telemedicine-based anesthesia evaluation and its effects on appointment completion.Methods: This was a retrospective, non-randomized, cohort study of adult patients at the University of California, Los Angeles, United States, who received preoperative anesthesia evaluations by telemedicine or in-person in an academic medical center. From January to September 2021, we evaluated telemedicine and in-person appointment completion in patients scheduled for surgery. The primary outcome was the incidence of appointment completion. The secondary outcomes included appointment no-shows and cancellations.Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%), fewer cancellations (12.55% vs 19.41%), and no statistical difference in appointment no-shows (6.07% vs 3.99%). Compared to the in-person group, patients who received telemedicine evaluations were younger (55. 81 ± 18.38 vs 65.97 ± 15.19), less likely Native American and Alaska Native (0.31% vs 1.60%), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%), required less interpreter services (4.18% vs 9.31%), had more private insurance coverage (53.45% vs 37.50%) and less Medicare coverage (37.03% vs 50.53%).Conclusions: This study demonstrates that telemedicine can improve preoperative anesthesia appointment completion and decrease appointment cancellations. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. These inequities highlight potential avenues to increase equity and access to telemedicine.

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Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis

Cited by 25 publications

References 47 publications

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments

Évaluation de la fiabilité de l’évaluation préanesthésique virtuelle des voies aériennes en comparaison à l’évaluation traditionnelle en personne : une étude observationnelle prospective

Improvement in Adherance to Anesthesia Preoperative Appointment With Telemedicine: A Retrospective Analysis

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